The Good, The Bad and The Ugly of Drug Prices

The vitriol and debate around the price of prescription drugs sometimes makes the Civil War look like a schoolyard skirmish. Every stakeholder in the pharmaceutical and healthcare industry is ready to fire bullets at someone else for the rising cost of prescriptions.

I’m reminded of Roco’s words from “The Good, The Bad and the Ugly”, the 1960’s Spaghetti Western starring Clint Eastwood, when he said (after gunning down his opponent), “when you have to shoot, shoot, don’t talk.” There seems to be a lot of shooting and blaming going on over drug prices today.

For pharmacists like myself who have been watching the market and working in this profession for over 20 years, we have a little different perspective on the problem. In fact, “The Good, The Bad and The Ugly” isn’t a bad outline for how to review the story around prescription prices.

The Good

What has been happening to prescription prices isn’t all bad. Not all drug prices are rising. I was around when competition in the generic drug market got so intense that retailers could offer consumers $4 and $9 generics for 30 and 90 days. Four dollars for medication that literally saves lives! In fact, some retailers have taken the low-price strategy so far as to offer free “30-day supplies” on some generics just to get people in their doors.

Has any other healthcare industry done this? Of course not. Has any other business done this? The closest equivalent is the fast-food “dollar” menu, and I venture to say that at least prescription medications are generally promoting your health, rather than hurting it. For consumers at least, this has been good.

The Bad

On the other hand, the prices for newer classes of drugs (and even some older generic drugs) have seen an astronomical increase. Newer COPD inhalers, oral diabetic meds, and insulins coming to the market have sticker prices in the upper hundreds of dollars per month. There was the outrage over the escalating price of EpiPen and of course Martin Shkreli’s 5000% increase on the price of Daraprim several years ago. And we haven’t even discussed the prices of the Hep C treatments and new treatments for cancer.

You don’t have to be an economist to understand that drug prices rising to the hundreds of thousands of dollars is unsustainable.

The Ugly

The “ugly” part of this whole problem is that there is no simple solution. As a professor at John Hopkins Bloomberg School of Public Health, Gerald Anderson, said in the Washington Post “It is so convoluted and so complicated. The PBMs have grown in power and profitability over the last 10 years,and are becoming a huge force. The drug companies, they're the ones that raise prices…we've got two bad actors, we don't have one."

Trump’s recent speech on drug prices didn’t, in my opinion, offer any tangible hope for a change. I just don’t see how raising prices abroad (if that can even happen) would necessarily lower prices here at home.

Blondie, played by Clint Eastwood in the Western Classic mentioned before, said “every gun makes its own tune.” The same seems to be true in the drug price debate. Everyone has a solution. I just hope someone figures it out, because patient lives depend on it.